Enye yeyona nkqubela ephambili kwindlela yokwelapha umhlaza wamaphaphu ivela ekuqondeni ukuguqulwa kwemfuyo kumaseli omhlaza wamaphaphu. Nangona esidlulileyo siphule i-cancer yephayiphu ukuya kwiintlobo ezinhlanu, ngoku siyazi ukuba akukho mdlavuza wesifo samaphaphu esifanayo. Ukuba bekukho abantu abangama-30 kwigumbi elinomdlavuza wamaphaphu, babeza kuba neentlobo ezahlukeneyo ezahlukeneyo zezifo ezingama-30.
Ukuba usandul 'ufumane ukuba nomhlaza wemiphunga, ikakhulukazi imiphunga ye-lung adenocarcinoma , i-oncologist yakho inokuthetha nawe malunga nokuhlolwa kofuzo (mhlawumbi eyaziwa ngokuba yiprofayili yecome molecule okanye ukuhlolwa kwe-biomarker) yesisu sakho. Ngoku kuyacetyiswa ukuba zonke izigulane zomdlavuza wamaphaphu ezineziphumo eziphambili okanye imetastatic lung adenocarcinoma (uhlobo lwesifo somhlaza wesininzi esingekho encinci) lunokuvavanya kwamanzi ukujonga utshintsho lwe-EGFR kunye ne-ALK kunye ne-ROS1.
Ukongeza, izigulane ezinezinye iintlobo zesifo somhlaza wesifo somhlaza (umzekelo, i-adenosquamous carcinoma kubantu abangabhemi) kufuneka ihlolwe kwakhona ukuze ihlolwe.
Uvavanyo Luni?
Ukuvavanya i-genetic kubandakanya iimvavanyo ezenza i-pathologist ebhodini usebenzisa isampuli yesikhumba sakho somhlaza. Ezi mvavanyo zijonge umdlavuza ukusuka kumanqanaba.
Izicubu zinokuvela kwi- biopsy ye-tumor yakho okanye kwiisishu ezisuswe ngexesha lotyando lomhlaza wemiphunga . Isizathu esilandelayo kukuba i-cancer ishintsho lomzimba kunye nezinye iitshintsho "eziqhuba" okanye ukulawula ukukhula komhlaza.
Ngokulula, ukuba ezi zinguqu zinokuthi zichongwe, zonyango zingasetyenziselwa ukuba "zijolise" ezi zinguqulelo, oko kukuyeka ukukhula komhlaza. Yiyo yintshintsho ekhokelela ekuphuhlisweni komhlaza kwindawo yokuqala.
Ngaphambi kokuya phambili, kunceda ukulungisa into edidisayo kubantu abaninzi.
Kukho iintlobo ezimbini ezibalulekileyo zokuguquka komzimba:
- Utshintsho oluthile. Kwakhona kuthiwa yi-germline mutations, oku kuthetha ukuba uzuze iirase kunye neenguqu ezivela kumzali omnye okanye ngaphezulu. Imizekelo eqhelekileyo yale miququlelo ibandakanya i- hemophilia kunye nezinguqu ezinokubangela umntu ukuba ahlakulele umdlavuza webele, njenge- BRCA1 ne- BRCA2 .
- Utshintsho oluthile. Uhlobo lokutshintshwa kwezinto oososayensi ababhekisele empeleni kubantu abanomdlavuza wamaphaphu kuthiwa bafumana ukuguqulwa kwamanzi, okanye ukuguqulwa kwamathambo). Ezi zinguqu azikho ngexesha lokuzalwa (kwaye aziqhubi kwiintsapho), kodwa kunokuba ziqhube kwinkqubo yeseli ibe ngumhlaza .
Ziziphi iinguqu ze-Gene?
Ukuguquka kweGenes kutshintshela kumzimba othile kwi-chromosome. Zonke iizakhi zenziwe ngokulandelelana kwezinto ezine-amino acids (ezibizwa ngokuba yiziseko) -adenine, tyrosine, i-cytosine kunye ne-guanine.
Xa i-gene ivuleleke kwiibhoksi kwimeko, okanye xa kwenzeka ingozi kwisahlulo seseli, utshintsho, okanye utshintsho, lunokwenzeka. Kwezinye iimeko, ithetha ukuba esinye isiseko sithatha indawo enye, njenge-adenine esikhundleni se-guanine. Kwezinye iimeko, iziseko zingeniswa, zisuswe, okanye zilungiswe ngandlela-thile.
Ukubaluleka kweentshukumo zeGene
Kutheni i-oncologists inomdla ekuguquleni kweemfuyo kwi-tumor?
Okokuqala, sifanele sithethe ngeentlobo ezimbini zokuguqulwa kwamagama atholakala kumagciwane omphunga:
- Utshintsho lomqhubi . Ezi zinguqu, ngokusebenzisa iindlela ezininzi, "ukuqhuba" ukukhula kwesisu. Emdlavuza wemiphunga, inani lokutshintshwa komqhubi liguqukile. Kwisifundo esinye, umyinge we-11 umtshintsho womqhubi ngomhlaza wafunyanwa.
- Utshintsho lwabagibeli. Kanye njengoko umntu engaba ngumgibeli emotweni, ezi zakhi zegesi aziqhubeki nomdlavuza, kodwa zihamba ngokukhwela. Kwakhona, asizi kakuhle ukuba zingaphi ukutshintshwa kwabagibeli kwi-tumor (kunye nenani liyahluka ukusuka kwisisu kuya kwisisu), kodwa ezinye izicubu zinokuba ngaphezulu kwe-1,000 kwezi zinguqulelo. Ukuguquka komqhubi akuqalisi kuphela ukuphuhliswa komhlaza, kodwa sebenzela ukugcina ukukhula komhlaza ngokunjalo.
Uguquko oluqhelekileyo lomqhubi
Kukho utshintsho oluthile olufundiswa yizinzulu zikhangele kwiimathumbu zamaphaphu. Kuze kube ngoku, ukuguqulwa komqhubi kuye kwafunyanwa malunga nama-60 eepesenti ye-lungen adenocarcinomas kwaye mhlawumbi le nani iya kwanda ngexesha.
Abaphandi ngoku bafumana utshintsho lomqhubi kumhlaza wesifo somhlaza wamaphaphu. Ngokuqhelekileyo, ezi zinguqu zenziwa ngokuzimeleyo kwaye azibonakali ukuba zingabonakali kwisisu esifanayo. Ukuguquka komqhubi oqhelekileyo kumdlavuza wamaphaphu kubandakanya:
- EGFR utshintsho
- Iinguqu zeKRAS
- Ukulungiswa kwe-EML4-ALK
- ROS1 ukulungiswa kwakhona
- MET amplification
- HER2 utshintsho
- Ukulungiswa kwakhona kweRET
- BRAF utshintsho
Unyango olumntu
Ukusetyenziswa "kwezilwanyana ezijoliswe kuyo," imithi ejolise kwizinto ezingafaniyo zofuzo kwi-tumor, iye yenziwa ngamayeza okhethekileyo okanye amayeza acacileyo. Kuthetha ukuthini ukuba, kunokuba isichengiselwano sesigqirha se-chemotherapy esichaphazelayo zonke iiseli ezihlula ngokukhawuleza, izilwanyana ezijoliswe kuhlobo oluthile oluqhelekileyo lukhona kuphela kumaseli omhlaza wakho.
Ngokuqhelekileyo, unyango olujoliswe kuzo luba nemiphumo emibini yecala ngaphandle kwekhemotherapy yendalo. Kuza kube yimhla, iipilisi ezijoliswe kuzo zivunyiwe abantu abanomdlavuza wamaphaphu ziquka:
- I-Tarceva (erlotinib) yabantu abanomdla wokuguquka kwe-EGFR (Qaphela: kukho iintlobo ezahlukeneyo zeinguqu ze-EGFR kwaye akubona bonke abaphendula ngokufanayo kule nto.)
- I-Xalkori (crizotinib) yabantu abanesifo se-ALK4-EML i-rearrangement yesigidi (Qaphela: I-FDA ivumile le ngo-2011 kwaye ke yanikwa isimo sokuphumelela kwesifo somhlaza we-ROS1 ngo-2015.)
Olunye unyango luye lwavunywa kwaye luye lwafundwa kwizilingo zeclini, kubandakanywa unyango olujoliswe kulabo abanesifo esixhatshazelayo kwiTarceva okanye i-Xalkori.
Ukunganyangeki kunyango
Ingxaki engumngeni kunye nokunyanga okujoliswe kuko okwangoku kuthi phantse wonke umntu unqabile ngokuchasene nonyango. Kukho iindlela ezininzi ezenzekayo okwenza kube nzima ukufumana isisombululo esisodwa. Uphando luqhubekayo kwiimvavanyo zeclini-ukuvavanya kokubili ukusetyenziswa kokutshintshwa kwesibini kwisizabisi ukujolisa ekutshintshisweni kunye neziyobisi ezisebenzisa iinjongo ezahlukeneyo okanye iindlela zokuhlasela iseli somhlaza.
U vavanya
Ukuvavanya ukuguqulwa kwemfuza kunye nokulungiswa kwakhona ngokuqhelekileyo kwenziwa kwiisampuli zamathambo ezitholakala kwindlela ethile yepopopy biopsy okanye i-biopsy ye-metastasis. Kodwa ngoJuni ka-2016, nangona kunjalo, uvavanyo lwe -biopsy lwamanzi lufumaneka njengendlela yokuvavanya uguquko lwe-EGFR kwabanye abantu. Ekubeni le mivavanyo ingenziwa ngokudweba kwegazi elula, oku kuhamba phambili ekuhloleni umhlaza womphunga.
ILizwi
Ukukwazi ukuqonda i-molecular profile of lung tumors yindawo enomdla kakhulu yophando, kwaye mhlawumbi ukuba unyango olutsha luya kufakwa kungekudala.
Umzekelo wendlela ngokukhawuleza le ngingqi yonyango iqhubela phambili yi-ALK4-EML ye-gene rearrangement. Olu gama "ukuguqulwa" (ngokwenene ukulungiswa kwakhona) kwafunyanwa ngoku kutshanje ngo-2007. Ngokuqhutywa kwenkqubo ekhawulezayo, i-Xalkori (crizotinib) yonyango yavunywa ngo-2011 ukuze isebenziswe ngokubanzi yi-FDA kwezo zi gulane ezinezikhumba ezinokuhlaziywa. Kukho iimvavanyo zeklinikhi eziqhubekayo ukuvavanya ukusetyenziswa kwezidakamizwa zesizukulwana sesibini kulabo abaye baxhatshazwa kwiXalkori.
Ukuba uye wafumanisa ukuba unomhlaza wesifo somhlaza wamangqamuzana, ingakumbi imiphunga ye-lung adenocarcinoma okanye umhlaza wesifo somhlaza wamagciwane, tshela ugqirha wakho malunga nokuhlolwa kofuzo. Nangona ukuvavanywa ngoku kunconywa kuwo wonke umntu onomdlavuza ongasetyenzana wamancinci wesifo samathambo, uphando olutshanje luchaze ukuba kuphela iipesenti ezingama-60 ze-oncologists okwangoku iyalela uvavanyo.
Unokufuna ukunxibelelana nogqirha wakho malunga novavanyo lweekliniki ezinokukhetha. Kungekudala, ilingo leklinikhi yomdlavuza wamaphaphu ehambelana nenkonzo ehambelana nemibutho yamanomdla eminye yemiphunga ikhona, kwakhona. Ngale nkonzo yamahhala, umqhubi we-nurseti oqeqeshiwe unokukunceda ukuba ufumane naziphi na izilingo zeclini ezinokukhetha.
> Imithombo:
> Ukuhlawula, T., Chawla, A., Batra, R., noRargia. Ulwaphulo olusenziwa ngumntu ngomdlavuza wamaphaphu: iindlela zamathambo, iindlela zokwelapha ezijoliswe kuyo, kunye nokubonakaliswa kwe-genomic. Uphuhliso lwezoMpilo kunye neBiology . 2014. 799: 85-117.
> Kim, H., Mitsudomi, T., Soo, R., no B. Cho. Ulwaphulo olwenziwe ngumntu kwi-horizontal ye-squamous cell carcinoma yomphunga. Cancer Lung . 2013. 80 (3): 249-55.
> Li, T., Kung, H., Mack, P., noD. Gandara. I-Genotyping kunye ne-genomic profiling ye-non-small-cell cell cancer. Umbhalo we-Clinical Oncology . 2013. 31 (8): 1039-49.
> Villaruz, L., Burns, T., Ramfidis, V. kunye noMn. Socinski. Ukuzenza unyango kwi-advanced cell non-small cell cancer. Iimviwo kwiMpilo yeMpilo yokuHluma nokuHlola . 2013. 34 (6): 822-36.